Gastro and repro

Comprehensive vocabulary flashcards covering Gastrointestinal, Genitourinary, Reproductive, Endocrine, Immunosuppressant, Chemotherapeutic, Hematopoietic, Cardiovascular, and Pulmonary Pharmacology based on lecture notes.

Ondansetron (Zofran)

A serotonin (5-HT3) receptor antagonist that blocks 5-HT3 receptors in the chemoreceptor trigger zone (CTZ) and GI tract; used to prevent and treat chemotherapy-induced, postoperative, and gastritis-related nausea and vomiting. A major adverse effect is QT-interval prolongation, which can lead to torsades de pointes.

Torsades de Pointes

A life-threatening polymorphic ventricular tachycardia associated with a prolonged QT interval that can be triggered by medications such as ondansetron.

Metoclopramide (Reglan)

A prokinetic and antiemetic agent that blocks dopamine (D2) receptors in the CTZ and acts as a 5-HT4 receptor agonist to stimulate acetylcholine release in the gut, thereby accelerating gastric emptying; used for gastroparesis, CINV, and postoperative nausea. Adverse effects include extrapyramidal symptoms (EPS) and Neuroleptic Malignant Syndrome (NMS).

Neuroleptic Malignant Syndrome (NMS)

A rare, life-threatening adverse reaction characterized by hyperthermia, severe muscle rigidity, altered level of consciousness, irregular pulse, tachycardia, and diaphoresis; associated with dopamine receptor antagonists such as metoclopramide.

Aprepitant (Emend)

A neurokinin-1 ($\text{NK}_1$) receptor antagonist that blocks the binding of substance P in the CTZ; primarily used as an adjunct to prevent acute and delayed chemotherapy-induced nausea and vomiting. It decreases the effectiveness of oral contraceptives and warfarin.

Scopolamine

A muscarinic acetylcholine receptor antagonist (anticholinergic) administered via a transdermal patch placed behind the ear to prevent motion sickness and postoperative nausea and vomiting; major side effects include sedation, dry mouth, urinary retention, and blurred vision.

Meclizine (Antivert)

A first-generation $H_1$ antihistamine with antimuscarinic activity that reduces stimulation to the vestibular-to-vomiting center pathway; indicated for vertigo and motion sickness.

Loperamide (Imodium)

An antidiarrheal medication that activates $\mu$-opioid receptors on the intestinal wall to slow transit time and decrease fluid discharge; available OTC up to a maximum daily dose of $8\,\text{mg}$, with high doses carrying a risk of QT prolongation.

Bismuth Subsalicylate (Pepto-Bismol)

An antidiarrheal agent that exhibits antimicrobial activity and reduces inflammation by decreasing prostaglandin synthesis; converts to salicylic acid and can cause harmless black stools or black tongue. It is contraindicated in children due to the risk of Reye syndrome.

Psyllium

A bulk-forming laxative that absorbs water into the stool, increasing fecal mass and promoting peristalsis; indicated for temporary constipation, diverticulosis, and IBS, and must be taken with at least $8\,\text{ounces}$ of fluid to prevent esophageal obstruction.

Docusate Sodium

A surfactant laxative (stool softener) that lowers surface tension to allow water and lipids to penetrate fecal mass while inhibiting intestinal fluid absorption; safe for pediatric patients aged 6 to 12.

Bisacodyl

A stimulant laxative that stimulates intestinal smooth muscle motility and reduces water and electrolyte absorption; available as enteric-coated tablets and suppositories that should not be taken with milk or antacids.

Alosetron (Lotronex)

A selective 5-HT3 receptor antagonist reserved for severe diarrhea-predominant irritable bowel syndrome (IBS-D) in women who fail other therapies; carries serious risks of severe constipation and ischemic colitis.

Lubiprostone (Amitiza)

A locally acting chloride channel activator that increases fluid secretion into the intestinal lumen to promote motility; indicated for constipation-predominant irritable bowel syndrome (IBS-C) and chronic idiopathic constipation.

Ulcerative Colitis (Colonoscopic Appearance)

An inflammatory bowel disease characterized on colonoscopy by continuous, mucosal erythema, friability, ulceration, and loss of vascular markings extending proximally from the rectum.

Crohn's Disease (Colonoscopic Appearance)

An inflammatory bowel disease characterized on colonoscopy by transmural inflammation showing skip lesions, discrete aphthous ulcers, a cobblestone mucosal pattern, and fibrotic stricturing.

Sulfasalazine (Azulfidine)

A 5-aminosalicylate (5-ASA) disease-modifying agent used for mild to moderate ulcerative colitis and Crohn's disease that suppresses prostaglandin synthesis and migration of inflammatory cells; potential adverse effects include rash, arthralgia, and bone marrow suppression.

Pancrelipase (Creon)

A mixture of digestive enzymes (lipase, protease, amylase) indicated for exocrine pancreatic insufficiency; must be administered orally with meals or snacks to facilitate fat, protein, and carbohydrate absorption.

Cimetidine (Tagamet)

A histamine-2 ($H_2$) receptor antagonist that reduces gastric acid secretion by blocking $H_2$ receptors on gastric parietal cells; side effects include antiandrogenic effects (e.g., gynecomastia, impotence), CNS disturbances in older adults, and inhibition of hepatic drug-metabolizing enzymes (raising warfarin levels).

Omeprazole (Prilosec)

A proton pump inhibitor (PPI) that irreversibly inhibits the $H^+/K^+\text{-ATPase}$ enzyme system in gastric parietal cells, suppressing the final step of acid production; long-term use is associated with hypomagnesemia, bone fractures, pneumonia, and acid rebound.

Sucralfate (Carafate)

A mucosal protective agent that forms a viscous, protective chemical barrier paste over duodenal ulcer craters against acid and pepsin; can cause constipation and must be administered at least 30 minutes apart from antacids.

Misoprostol (Cytotec)

A synthetic prostaglandin E analog that suppresses gastric acid secretion, promotes bicarbonate and mucus secretion, and maintains mucosal blood flow to prevent NSAID-induced ulcers; strictly contraindicated in pregnancy due to its ability to induce uterine contractions.

Phenazopyridine (Pyridium)

An azo dye that exerts a direct local analgesic effect on the urinary tract mucosa to relieve dysuria, burning, and urgency; turns urine a harmless bright reddish-orange color that can stain clothing and interfere with urine dipstick tests.

Finasteride (Proscar)

A 5-alpha reductase inhibitor that blocks the conversion of testosterone to dihydrotestosterone (DHT) in the prostate gland, leading to the regression of prostatic epithelial tissue and relief of mechanical bladder outlet obstruction in BPH.

Tamsulosin (Flomax)

A selective $\alpha_1$-adrenergic receptor antagonist that relaxes smooth muscle in the prostate stroma and bladder neck to improve dynamic urinary flow in benign prostatic hyperplasia (BPH); can cause orthostatic hypotension and dizziness.

Oxybutynin (Ditropan)

An anticholinergic antispasmodic agent that blocks muscarinic $M_3$ receptors in the bladder detrusor muscle, reducing involuntary contractions and urinary urgency in overactive bladder; common adverse effects include dry mouth, blurred vision, tachycardia, and urinary retention.

Magnesium Sulfate (Obstetric)

An intravenous tocolytic and neuroprotective agent that acts as a calcium antagonist to decrease smooth muscle contractility and excitotoxic neuronal injury; toxicity is signaled by loss of deep tendon reflexes, respiratory depression, and oliguria, and is reversed with calcium gluconate.

Oxytocin

A posterior pituitary hormone analog administered by titrated IV infusion to induce or augment uterine contractions during labor and to increase uterine tone to control postpartum hemorrhage.

Terbutaline

A selective $\beta_2$-adrenergic agonist that relaxes uterine smooth muscle to reduce the frequency and intensity of preterm contractions; side effects include maternal tachycardia, hypotension, nervousness, hypokalemia, and hyperglycemia.

Tamoxifen

A selective estrogen receptor modulator (SERM) that blocks estrogen receptors on breast tissue to treat and prevent estrogen-receptor-positive breast cancer; increases the risk of endometrial cancer, pulmonary embolism, and deep vein thrombosis.

Insulin Lispro (Humalog)

A rapid-acting insulin analog with an onset of $15\text{--}30\,\text{minutes}$, peak effect at $0.5\text{--}3\,\text{hours}$, and duration of $3\text{--}5\,\text{hours}$; administered immediately before or with meals to control postprandial glucose.

Regular Insulin (Humulin R, Novolin R)

A short-acting, clear insulin formulation with an onset of $30\text{--}60\,\text{minutes}$, peak at $1\text{--}5\,\text{hours}$, and duration of $6\text{--}10\,\text{hours}$; the only insulin formulation approved for continuous intravenous administration.

NPH Insulin (Humulin N, Novolin N)

An intermediate-acting, cloudy insulin suspension with an onset of $1\text{--}2\,\text{hours}$, peak effect at $4\text{--}14\,\text{hours}$, and duration of $14\text{--}24\,\text{hours}$; when mixed in a syringe with regular insulin, clear (regular) is drawn before cloudy (NPH).

Insulin Glargine (Lantus)

A long-acting basal insulin analog with an onset of $1\text{--}4\,\text{hours}$, no pronounced peak, and a duration of approximately $24\,\text{hours}$; forms micro-precipitates in subcutaneous tissue to provide steady, continuous glycemic control.

Glipizide (Glucotrol)

A second-generation sulfonylurea antidiabetic agent that stimulates the release of insulin from functioning pancreatic beta cells; major adverse effects include hypoglycemia and weight gain, requiring patients not to skip meals.

Metformin (Glucophage)

A biguanide oral antihyperglycemic that decreases hepatic glucose production, enhances peripheral insulin sensitivity, and reduces intestinal glucose absorption; carries a risk of lactic acidosis and must be withheld prior to and 48 hours following iodinated radiocontrast procedures.

Glucagon

A hyperglycemic polypeptide hormone that promotes the breakdown of glycogen into glucose in the liver; administered parenterally (IM/SQ) for emergency management of severe hypoglycemia when oral or IV glucose access is unavailable.

Levothyroxine (Synthroid)

A synthetic preparation of tetraiodothyronine ($T_4$) used as lifelong hormone replacement therapy in hypothyroidism; must be taken on an empty stomach in the morning, and overdosage can cause thyrotoxic symptoms (tachycardia, tremors, insomnia, atrial fibrillation).

Methimazole (Tapazole)

A thionamide antithyroid drug that inhibits the synthesis of thyroid hormones by preventing the incorporation of iodine into tyrosine residues; indicated for hyperthyroidism and Graves' disease, with agranulocytosis being its most dangerous adverse effect.

Cyclosporine (Sandimmune)

A calcineurin inhibitor that blocks transcription of interleukin-2 ($\text{IL-2}$), thereby halting T-cell proliferation and preventing solid-organ transplant rejection; adverse effects include nephrotoxicity, hypertension, gingival hyperplasia, and hyperkalemia. Blood levels are increased by grapefruit juice.

Sirolimus (Rapamune)

An immunosuppressive agent that binds to immunophilins to inhibit mammalian target of rapamycin (mTOR), arresting T-cell and B-cell activation; used to prevent renal allograft rejection, with adverse effects of hyperlipidemia, nephrotoxicity, pneumonitis, and impaired wound healing.

Methotrexate

An antimetabolite and folate analog that competitively inhibits dihydrofolate reductase, blocking folic acid conversion during the S-phase of the cell cycle; indicated for leukemias, lymphomas, rheumatoid arthritis, and ectopic pregnancy, with risks of severe pancytopenia and mucositis.

Fluorouracil (5-FU)

A pyrimidine analog antimetabolite that incorporates into RNA and inhibits thymidylate synthase during the S-phase of the cell cycle, disrupting DNA synthesis in solid tumors; classic adverse effects include bone marrow suppression, stomatitis, and hand-foot syndrome.

Doxorubicin (Adriamycin)

An anthracycline antitumor antibiotic that intercalates into DNA and inhibits topoisomerase II in a non-cell-cycle-specific manner; it is a severe IV vesicant, causes harmless red-colored urine/sweat, and carries cumulative lifetime dose-dependent cardiotoxicity leading to heart failure.

Vincristine

A vinca alkaloid chemotherapeutic agent that binds tubulin to disrupt the mitotic spindle apparatus during the M-phase; causes dose-limiting peripheral and autonomic neuropathies, is an IV vesicant, and carries a fatal safety alert stating it must NEVER be administered intrathecally.

Cisplatin

A platinum-based alkylating-like chemotherapeutic drug that creates DNA cross-links to impede replication and transcription; notable toxicities include severe renal toxicity, ototoxicity, and profound emetogenic potential.

Epoetin Alpha (Epogen, Procrit)

A recombinant glycoprotein hematopoietic growth factor that stimulates erythropoiesis in chronic renal failure and non-myeloid malignancies; adverse cardiovascular events and mortality increase significantly when hemoglobin exceeds $11\,\text{g/dL}$ or rises by more than $1\,\text{g/dL}$ within 2 weeks.

Filgrastim (Neupogen)

A granulocyte colony-stimulating factor (G-CSF) that stimulates bone marrow production and maturation of neutrophils; given to reduce infection risk following myelosuppressive chemotherapy, with bone pain and leukocytosis being the most common adverse effects.

Oprelvekin (Interleukin-11)

A recombinant thrombopoietic growth factor that acts on hematopoietic stem cells to stimulate platelet production in myelosuppressive chemotherapy; commonly causes fluid retention, dilutional anemia, and atrial dysrhythmias.

Hydroxyurea (Hydrea, Droxia)

A ribonucleotide reductase inhibitor that interferes with DNA precursor synthesis; used in sickle cell anemia to increase fetal hemoglobin and reduce painful vaso-occlusive crises, as well as in chronic myeloid leukemia (CML).

Cardiac Conduction System

The specialized neuromuscular pathway coordinating cardiac depolarization: the SA node fires (P wave), passes through internodal pathways to the AV node (PR segment delay), travels down the bundle of His, bundle branches, and Purkinje fibers to trigger ventricular depolarization (QRS complex), followed by repolarization (T wave).

Supraventricular Tachycardia (SVT)

A rapid, regular tachydysrhythmia arising above the bifurcation of the bundle of His with narrow QRS complexes and obscured P waves; typically treated acutely with vagal maneuvers, adenosine IV push, or rate-controlling agents.

Atrial Fibrillation (A-Fib)

A chaotic, irregularly irregular supraventricular dysrhythmia characterized by the absence of distinct P waves and variable ventricular response; treatment centers on rate control (beta-blockers, diltiazem), rhythm conversion (amiodarone), and thromboembolism prevention.

Ventricular Tachycardia (VT)

A wide-complex tachydysrhythmia originating from ectopic foci within the ventricles, characterized by consecutive wide QRS complexes at an elevated rate; requires immediate assessment of perfusion and treatment via electrical cardioversion or antiarrhythmics like amiodarone or lidocaine.

Ventricular Fibrillation (VF)

A lethal, pulseless dysrhythmia characterized by chaotic, erratic, uncoordinated ventricular electrical activity without identifiable waveforms, resulting in no cardiac output; requires emergent defibrillation and CPR.

Atrioventricular (AV) Blocks

Conduction delays or interruptions between the atria and ventricles, classified into first-degree (prolonged PR interval), second-degree Mobitz I (progressive PR lengthening before dropped QRS), second-degree Mobitz II (intermittent dropped QRS with constant PR), and third-degree (complete AV dissociation).

Furosemide (Lasix)

A high-ceiling loop diuretic that blocks sodium and chloride reabsorption in the thick ascending limb of the loop of Henle; produces rapid, profound diuresis used for heart failure and pulmonary edema. Can cause severe hypokalemia, hyponatremia, dehydration, hypotension, and ototoxicity.

Hydrochlorothiazide (HCTZ)

A thiazide diuretic that inhibits sodium and chloride reabsorption in the early distal convoluted tubule; used for hypertension and mild heart failure, but becomes ineffective when renal function declines to a GFR below $20\,\text{mL/min}$.

Spironolactone (Aldactone)

A potassium-sparing diuretic and competitive aldosterone antagonist that acts in the distal nephron to promote sodium excretion while retaining potassium; adverse effects include hyperkalemia and endocrine disturbances like gynecomastia and menstrual irregularities.

Mannitol

An osmotic diuretic administered as a continuous IV infusion that draws water from swollen intracellular/tissue spaces into the vascular system; used to decrease intracranial pressure (ICP) and intraocular pressure (IOP).

Renin-Angiotensin-Aldosterone System (RAAS)

A neurohormonal cascade where renin converts angiotensinogen to angiotensin I, ACE converts angiotensin I to angiotensin II (causing vasoconstriction and remodeling), and angiotensin II triggers aldosterone release to retain sodium and water while excreting potassium, ultimately increasing blood pressure.

Captopril

An angiotensin-converting enzyme (ACE) inhibitor that reduces angiotensin II levels and increases bradykinin; indicated for hypertension, heart failure, and diabetic nephropathy. Adverse effects include a persistent dry cough, hyperkalemia, first-dose hypotension, and angioedema.

Angioedema

A rapid, potentially life-threatening swelling of the deep dermis, submucosa, and airway tissues (lips, tongue, glottis) caused by bradykinin accumulation during ACE inhibitor therapy.

Losartan

An angiotensin II receptor blocker (ARB) that selectively blocks $AT_1$ receptors, causing vasodilation and aldosterone suppression without inhibiting kinase II; lowers blood pressure without inducing a bradykinin-mediated dry cough.

Aliskiren (Tekturna)

A direct renin inhibitor (DRI) that tightly binds renin to block the cleavage of angiotensinogen into angiotensin I; approved strictly for hypertension, carrying risks of hyperkalemia, angioedema, and fetal toxicity.

Lidocaine (Class Ib Antiarrhythmic)

A Class Ib sodium channel blocker administered intravenously to suppress ventricular dysrhythmias by decreasing automaticity and conduction velocity; toxic blood levels produce central nervous system effects including drowsiness, confusion, paresthesias, and seizures.

Flecainide (Class Ic Antiarrhythmic)

A Class Ic sodium channel blocker that profoundly slows cardiac conduction velocity; indicated for maintaining sinus rhythm in paroxysmal atrial fibrillation, but contraindicated post-myocardial infarction due to increased mortality risk.

Amiodarone (Cordarone)

A Class III potassium channel blocker with Class I, II, and IV properties that prolongs action potential duration and effective refractory period across atrial and ventricular tissues; toxicities include pulmonary fibrosis, thyroid dysfunction, hepatotoxicity, corneal microdeposits, and blue-gray skin discoloration.

Diltiazem (Cardizem)

A non-dihydropyridine calcium channel blocker that slows SA node automaticity, delays AV node conduction, and reduces myocardial contractility; indicated for rate control in atrial fibrillation, atrial flutter, and SVT, but contraindicated in advanced AV blocks.

Digoxin (Lanoxin)

A positive inotropic and negative chronotropic cardiac glycoside that inhibits the $\text{Na}^+/\text{K}^+\text{-ATPase}$ pump, increasing intracellular calcium and contractility while slowing AV node conduction; has a narrow therapeutic range of $0.5\text{--}0.8\,\text{ng/mL}$, with toxicity reversed by Digifab.

Adenosine (Adenocard)

An endogenous nucleoside administered as a rapid IV push followed immediately by a saline flush to terminate paroxysmal supraventricular tachycardia (SVT); suppresses AV node conduction and causes transient asystole, flushing, dyspnea, and a dying-like sensation.

Hydralazine

A direct-acting vasodilator that causes selective arteriolar dilation, reducing systemic vascular resistance and cardiac afterload; commonly induces reflex tachycardia and fluid retention, often necessitating combination therapy with a beta-blocker and a diuretic.

Nitroglycerin

An organic nitrate that converts to nitric oxide, causing predominant venodilation, pooling of venous blood, and reduction of cardiac preload and oxygen demand; transdermal patches require a daily 10-to-12-hour nitrate-free interval to prevent tolerance.

Sodium Nitroprusside (Nitropress)

A potent, rapid-acting IV vasodilator that directly relaxes arteriolar and venous smooth muscle to lower blood pressure immediately in hypertensive crises; continuous infusions beyond 3 days pose a risk of thiocyanate and cyanide toxicity.

Extravasation

The inadvertent infiltration and leakage of a vesicant medication or solution from a vascular access site into surrounding subcutaneous tissue, causing pain, erythema, severe blistering, necrosis, and ulceration.

High-Alert Medications

Medications defined by the Institute for Safe Medication Practices (ISMP) as having a heightened risk of causing significant or devastating patient harm when used in error; requires extra safeguards, verification policies, and independent double-checks.

Alpha-1 ($\alpha_1$) Adrenergic Receptor

A post-synaptic adrenergic receptor located primarily on vascular smooth muscle; activation results in vasoconstriction ('squeeze'), raising systemic peripheral vascular resistance and elevating blood pressure.

Alpha-2 ($\alpha_2$) Adrenergic Receptor

A presynaptic adrenergic receptor in the central and autonomic nervous systems; activation inhibits norepinephrine release ('slow/stop'), downregulating sympathetic outflow to reduce blood pressure.

Beta-1 ($\beta_1$) Adrenergic Receptor

An adrenergic receptor predominantly found in cardiac tissue ('1 heart'); stimulation produces positive chronotropic, inotropic, and dromotropic responses, increasing heart rate, contractility, and cardiac output.

Beta-2 ($\beta_2$) Adrenergic Receptor

An adrenergic receptor located in bronchial smooth muscle ('2 lungs') and select vascular/uterine smooth muscles; activation promotes cyclic AMP accumulation, leading to bronchial smooth muscle relaxation and bronchodilation.

Epinephrine (Adrenalin)

A nonselective adrenergic agonist that activates $\alpha_1$, $\alpha_2$, $\beta_1$, and $\beta_2$ receptors; used in cardiac arrest, severe anaphylaxis, and to delay local anesthetic absorption. Extravasation is countered with the alpha-adrenergic antagonist phentolamine.

Norepinephrine (Levophed)

A potent catecholamine vasopressor acting on $\alpha_1$, $\alpha_2$, and $\beta_1$ adrenergic receptors (lacking $\beta_2$ activity); indicated as first-line therapy for severe hypotension and septic shock to increase mean arterial pressure.

Albuterol (Ventolin)

A short-acting $\beta_2$-adrenergic agonist (SABA) that rapidly relaxes bronchial smooth muscle; used as an acute rescue bronchodilator for asthma and exercise-induced bronchospasm. Common side effects include tremors, tachycardia, and hypokalemia.

Salmeterol (Serevent)

A long-acting $\beta_2$-adrenergic agonist (LABA) providing bronchodilation for up to 12 hours on a fixed dosing schedule; used for maintenance in asthma and stable COPD, and must always be combined with an inhaled corticosteroid in asthma.

Prazosin (Minipress)

A selective competitive $\alpha_1$-adrenergic receptor antagonist that dilates arterioles and veins while relaxing bladder neck smooth muscle; often prescribed at bedtime to mitigate severe first-dose orthostatic hypotension and syncope.

Metoprolol (Lopressor)

A cardioselective $\beta_1$-adrenergic receptor antagonist that decreases heart rate, contractility, and renin secretion; indicated for hypertension, angina, and heart failure, with precautions for masking hypoglycemia and rebound tachycardia upon abrupt cessation.

Metered-Dose Inhaler (MDI) with Spacer

An inhalation delivery system combining a handheld canister with a chamber that suspends the aerosolized drug; increases pulmonary drug deposition from 9% (without spacer) to 21% while reducing oropharyngeal deposition from 81% to 22%.

Dry-Powder Inhaler (DPI)

A breath-activated device that delivers micronized dry medication directly into the lungs upon rapid, deep inspiration, eliminating the hand-breath coordination required by MDIs.

Nebulizer

A drug-delivery machine that converts liquid medication into a fine aerosol mist administered over several minutes via a mouthpiece or face mask; suitable for patients unable to generate sufficient inspiratory flow for an MDI or DPI.

Budesonide (Pulmicort)

An inhaled corticosteroid (ICS) that suppresses airway inflammatory cascades, reducing mucosal edema and hyperreactivity in persistent asthma; patients must rinse the mouth with water after use to prevent oropharyngeal candidiasis (thrush) and dysphonia.

Montelukast (Singulair)

An oral leukotriene receptor antagonist that blocks cysteinyl leukotriene receptors to reduce airway inflammation, bronchoconstriction, and mucus secretion in chronic asthma; carries an FDA warning regarding neuropsychiatric events (e.g., agitation, depression, suicidal ideation).

Cromolyn Sodium

A mast cell stabilizer that prevents calcium influx to stabilize the cytoplasmic membrane of mast cells, inhibiting histamine and leukotriene release; used prophylactically via nebulizer for allergen- or exercise-induced asthma.

Omalizumab (Xolair)

A recombinant humanized monoclonal antibody that selectively binds free circulating IgE, preventing its attachment to mast cells and basophils; indicated as long-term subcutaneous maintenance therapy for moderate-to-severe allergic asthma.

Roflumilast (Daliresp)

An oral phosphodiesterase-4 (PDE-4) inhibitor that increases cyclic AMP in lung cells to reduce exacerbations in severe COPD; it is strictly an anti-inflammatory drug, not a bronchodilator, and is associated with weight loss and psychiatric symptoms.

Theophylline (Theo-24)

An oral and IV methylxanthine bronchodilator that relaxes bronchial smooth muscle, requiring therapeutic drug monitoring ($5\text{--}15\,\mu\text{g/mL}$); toxicity can cause life-threatening ventricular dysrhythmias and intractable seizures.

Ipratropium (Atrovent)

A short-acting muscarinic antagonist (SAMA) that blocks acetylcholine-mediated muscarinic receptors in bronchial smooth muscle to promote bronchodilation; adverse effects include dry mouth, cough, and urinary retention.

Tiotropium (Spiriva)

A long-acting muscarinic antagonist (LAMA) administered once daily via DPI or Respimat to provide continuous bronchodilation in maintenance therapy of COPD.

Fluticasone (Flonase)

An intranasal glucocorticoid that suppresses inflammatory mediators to prevent and treat allergic rhinitis symptoms; spray should be directed away from the nasal septum toward the lateral nasal wall to avoid mucosal perforation and epistaxis.

Pseudoephedrine (Sudafed)

An oral sympathomimetic decongestant that stimulates $\alpha_1$-adrenergic receptors to constrict dilated nasal mucosal arterioles; subject to federal purchase limits under the Combat Methamphetamine Epidemic Act, with adverse effects including tachycardia, hypertension, and insomnia.

Dextromethorphan

A non-opioid antitussive agent that acts directly on the cough center in the medulla to suppress dry, nonproductive coughs; contraindicated with monoamine oxidase inhibitors (MAOIs) due to the risk of serotonin syndrome.